Whiplash Injury Treatment

Whiplash Injury Treatment

Technically, whiplash occurs when the body is suddenly accelerated then decelerated, which is precisely what happens in a “rear-ender” car accident: upon impact from behind, the torso accelerates rapidly to the same speed as the colliding car. Because of the neck’s flexiblity, the head simultaneously arcs backward, injuring soft tissue structures (muscle, ligaments and tendons) around the neck and upper shoulders. When the force of the collision stops (within one second), the torso suddenly stops, but the head accelerates forward and over corrects, causing the neck to sharply flex (bend) forward resulting in further soft tissue injury. In severe cases, ligaments rupture causing joint instability; nerve injury may occur, as well as fractures. Some victims may even experience concussions or subdural hematomas (swelling in cranium).

Immediately after a whiplash event that results in soft tissue injury, swelling starts, very gradually. The injured tissues release a variety of inflammatory products which irritate nerve endings and cause pain. As the swelling progresses, it increases internal pressure in the joints, causing them to stiffen. Typically, swelling following a whiplash accident peaks 72 hours after the accident. This explains why your neck hurts the most several hours after the accident, instead of immediately after the accident.

It is important to know that whiplash can occur from even low velocity collisions. The reason is that the kinetic energy (force) of a car is very high, even at five miles per hour, due to the large mass of the car. This energy is transferred to the occupants of the vehicle and is actually more violent if the cars do not deform (dent), which is often the case in low impact collisions. Therefore, even if you were in a low-impact accident that was enough to cause a whiplash effect, It is advisable to get checked to make sure problems don’t develop later on.


For whiplash patients, the first order of business is to determine the extent of the injury. First and foremost, conditions requiring emergency medical attention will need to be ruled out. These include:

• Spinal fracture
• Ligament rupture
• Hematoma (bleeding in the brain)
• Peripheral Nerve damage
• Ruptured blood vessels

Advanced imaging like an MRI, CT scan, or video flouroscopy may be ordered if any of these conditions are suspected. Once they are ruled out, manual therapy with adjunctive physiotherapy is initiated.

The overall goal of treatment is to reduce pain, restore function, and strengthen/rehab the neck so that proper healing occurs and the chances of chronic pain are minimized.

Headache after whiplash injury is common. After neck pain it is the second commonest symptom that whiplash injury patients experience. The whiplash headache can often outweigh the neck pain in terms of severity – particularly in the early weeks after injury.

Nearly two thirds of whiplash injury patients experience headache. About half of those who develop headache after whiplash injury feel the pain in the back of their head, a further third get headache all over the head and a smaller number feel the whiplash headache at their forehead or behind their eyes.

Headache after whiplash injury often shows itself for the first time on the morning after the accident. The pain sweeps up from the neck and over the back of the head. Most whiplash headache sufferers find that heat on the back of the neck will ease the headache. Cold makes it worse.

Neck movements often aggravate whiplash injury headache – particularly if the neck is moved towards extension: looking up to the ceiling is often very painful.

Patients with whiplash related headache often also get shoulder pain and touching the upper, middle and lower trapezius muscles over the back of the neck and shoulders often provokes pain or headache. There are often tender spots or trigger points in these muscles.

Women get headache after whiplash injury more often than men – the reason for this is unclear but might relate to the smaller structures of the female neck anatomy.

So what causes whiplash injury headache? Many research studies have looked to explain why whiplash injury causes headache. It seems most likely that the headache after whiplash injury arises from a mixture of inflammation in the neck muscles and irritation of the nerves that go from the neck, up and over the head.

Whiplash research has shown that whiplash injury headache can persist for a year or more in some patients – but for most the head pain improves within a month or two of the accident.

How should whiplash injury headache be treated? Well, the research is not good quality so there is no definitive answer to this. In my experience the headache is often quickly improved by hands on physical therapy or by acupuncture. Anti-inflammatory tablets help some patients and – for a minority of whiplash injury headache patients – injections deep into the spinal tissues can transform the situation.

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